Health Promotion Across the Lifespan

A client experiencing acute alcohol withdrawal is upset about going through detoxification. Which goal should be the priority for the nurse? - The client will commit to a drug-free lifestyle. - The client will work with the nurse to remain safe. - The client will drink adequate fluids daily. - The client will make a personal inventory of strengths.

- The client will work with the nurse to remain safe. Explanation: The priority goal in alcohol withdrawal is maintaining the client's safety. Committing to a drug-free lifestyle, drinking plenty of fluids, and identifying personal strengths are important goals, but ensuring the client's safety is the nurse's top priority.

The nurse is evaluating the lifestyle modifications a client has made to prevent gastroesophageal reflux. Which statement indicates that the client understands how to prevent reflux? - "I lie down and rest for 45 minutes after each meal." - "I sleep on my left side at night to help my stomach empty more quickly." - "I try to eat smaller amounts of food more often throughout the day." - "I've increased my fluid intake at meals to help improve my digestion."

- "I try to eat smaller amounts of food more often throughout the day." Explanation: To prevent gastric distention and gastroesophageal reflux, the client is encouraged to: - eat smaller, more frequent meals - not lie down until 2 to 3 hours after a meal - sleep with the head of the bed elevated 4 to 6 inches - Fluid intake should be restricted during meals to decrease gastric distention. These activities facilitate esophageal emptying and decrease episodes of reflux.

A nurse is teaching a client about type 2 diabetes mellitus. What information would reduce a client's risk of developing this disease? - "You should stop cigarette smoking." - "Follow a high-protein diet including meat, dairy, and eggs." - "Maintain weight within normal limits for your body size and muscle mass." - "Prevent developing hypertension by reducing stress and limiting salt intake."

- "Maintain weight within normal limits for your body size and muscle mass." Explanation: The most important factor predisposing to the development of type 2 diabetes mellitus is obesity. Insulin resistance increases with obesity. Cigarette smoking is not a predisposing factor, but it is a risk factor that increases complications of diabetes mellitus. A high-protein diet does not prevent diabetes mellitus, but it may contribute to hyperlipidemia. Hypertension is not a predisposing factor, but it is a risk factor for developing complications of diabetes mellitus.

The nurse is teaching the client with hypertension about maintaining an exercise program. Which teaching strategy will be most helpful? - Give the client a written exercise program to follow. - Explain the exercise program to the client's spouse. - Offer reassurance that that the client can follow the exercise program. - Tailor a program to the meet client's needs and abilities.

- Tailor a program to the meet client's needs and abilities. Explanation: Tailoring or individualizing a program to the client's lifestyle has been shown to be an effective strategy for changing health behaviors. Providing a written program, explaining the program to the client's spouse, and reassuring the client that he or she can do the program may be helpful but are not as likely to promote adherence as individualizing the program.

A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and the client's immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client?

- The nurse is caring for this client on the intensive care unit. Explanation: This client is critically ill; the client's diagnosis and immunosuppression place them at a high risk for infection. The most appropriate place for this client is in an intensive care unit, where the nurse can focus exclusively on health promotion. This client shouldn't be on the oncology floor. This client requires close monitoring. The nurse caring for this client shouldn't also be caring for other clients who may require frequent interventions.

The nurse is teaching a client about managing a hiatal hernia. Which lifestyle modification should the nurse encourage the client with a hiatal hernia to include in activities of daily living? - engaging in daily aerobic exercise - eliminating smoking and alcohol use - balancing activity and rest - avoiding high-stress situations

- eliminating smoking and alcohol use Explanation: Smoking and alcohol use both reduce esophageal sphincter tone and can result in reflux. They therefore should be avoided by clients with hiatal hernia. Daily aerobic exercise, balancing activity and rest, and avoiding high-stress situations may increase the client's general health and well-being, but they are not directly associated with hiatal hernia.

A client with hypertension visits the health clinic for a routine checkup. The nurse measures the client's blood pressure at 184/92 mm Hg and notes a 5-lb (2.3-kg) weight gain within the past month. Which nursing diagnosis reflects the most serious problem in managing a client with hypertension?

- Noncompliance (nonadherence to therapeutic regimen) Explanation: Noncompliance is the most serious problem in managing a client with hypertension. One authority estimates that 40% to 60% of hypertensive clients fail to comply with ordered treatment. Reasons for noncompliance include: - lack of symptoms, which makes the problem seem less serious - the difficulty of making required lifestyle changes, such as eating a low-sodium diet, stopping smoking, and losing or managing weight - adverse reactions to antihypertensive drugs; and the inconvenience and high cost of obtaining healthcare.

The nurse is teaching a wellness class to a group of adults. The nurse should tell the group that which factor places a person at the greatest risk for skin cancer?

- fair skin and history of chronic sun exposure Explanation: People who have fair skin and high exposure to ultraviolet light are at increased risk for malignant neoplasms of the skin. The other risk factors include exposure to tar and arsenicals and family history. A history of hypertension is a coronary artery disease risk factor. Clients with dark skin have increased melanin and are not as prone to skin cancer.

An employer establishes a physical exercise area in the workplace and encourages all employees to use it. This is an example of which level of health promotion? - primary prevention - secondary prevention - tertiary prevention - passive prevention

- primary prevention Explanation: - Primary prevention precedes disease and applies to healthy clients - Secondary prevention focuses on clients who have health problems and are at risk for developing complications - Tertiary prevention focuses on rehabilitating clients who already have a disease or disability. Passive prevention enables clients to gain health as a result of others' activities without doing anything themselves.

The nurse providing health promotion education to the parents of a 6-year-old child should include which statements about 6-year-old children in the education? - "They are completely dependent on parents." - "They rebel against schedules and routines." - "They are very sensitive to criticism." - "They love to tattle on other children."

- "They are very sensitive to criticism." Explanation: A nurse should explain that a 6-year-old child has a precarious sense of self that can cause overreaction to criticism and a sense of inferiority. By age 6, most children no longer depend on the parents for daily tasks and actually love the routine of a schedule. Tattling is more common at age 4 or 5; by age 6, the child wants to make friends and be a friend.

A nurse is teaching a class about osteoporosis. Which factors place a client at greater risk for developing this disease? Select all that apply. - postmenopausal status - long-term use of corticosteroids - long-term use of ibuprofen - excessive intake of calcium supplements - early onset of menses - sedentary lifestyle

- postmenopausal status - long-term use of corticosteroids - Sedentary lifestyle Explanation: The greatest incidence of osteoporosis occurs between ages 50 and 70 years. Risk factors include: - postmenopausal status - long-term use of corticosteroids - immobility and lack of exercise, and calcium deficiency Long-term ibuprofen use and early onset of menses are not considered risk factors for osteoporosis.

The nurse is administering enoxaparin to a client 6 hours before the scheduled time of laparoscopically assisted vaginal hysterectomy. Which is the intended therapeutic action of the enoxaparin? - increase in red blood cell production - reduction of postoperative thrombi - decrease in postoperative bleeding - promotion of tissue healing

- reduction of postoperative thrombi Explanation: Research findings have shown that enoxaparin and low-dose heparin given 6 - 12 hours preoperatively reduce the incidence of deep vein thrombosis and pulmonary emboli by 60% in clients who are at risk for deep vein thrombosis, such as those who are placed in the lithotomy position. Enoxaparin does not affect red blood cell production, postoperative bleeding, or tissue healing.

A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction? - "Limit yourself to smoking only 2 cigarettes per day." - "Eat a high-sodium diet." - "Weigh yourself daily and report a gain of 2 lb (0.91 kg) in 1 day." - "Maintain bed rest."

- "Weigh yourself daily and report a gain of 2 lb (0.91 kg) in 1 day." Explanation: The nurse should instruct the client to weigh themselves daily and report a gain of 2 lb (0.91 kg) in 1 day. COPD causes pulmonary hypertension, leading to right-sided heart failure or cor pulmonale. The resultant venous congestion causes dependent edema. A weight gain may further stress the respiratory system and worsen the client's condition. The nurse should also instruct the client to eat a low-sodium diet to avoid fluid retention and engage in moderate exercise to avoid muscle atrophy. The client shouldn't smoke at all.

The nurse is participating in a blood pressure screening event. After a client has three separate readings taken at least 2 minutes apart, the nurse determines that the client has a blood pressure of 160/90 mm Hg. What should the nurse advise the client to do? - Have their blood pressure evaluated again within 1 month. - Begin an exercise program. - Examine their lifestyle to decrease stress. - Make an appointment with a health care provider.

- Make an appointment with a health care provider. Explanation: The client with a blood pressure of 160/90 mm Hg has stage 2 hypertension. The nurse should advise the client to make an appointment with a health care provider as soon as possible. Exercise and stress reduction may be desirable activities, but it is first necessary to evaluate and treat the cause of elevated blood pressure.

One goal in caring for a client with arterial occlusive disease is to promote vasodilation in the affected extremity. What should the nurse instruct the client to do to achieve this goal? - Avoid eating low-fat foods. - Elevate the legs above the heart. - Stop smoking. - Jog daily

- Stop smoking. Explanation: Nicotine causes vasospasm and impedes blood flow. Stopping smoking is the most significant lifestyle change the client can make. Other interventions include: - The client should eat low-fat foods as part of a balanced diet. - The legs should not be elevated above the heart because this will impede arterial flow. The legs should be in a slightly dependent position `Jogging is not necessary and probably is not possible for many clients with arterial occlusive disease (no blood flow means no movement) A rehabilitation program that includes daily walking is suggested.

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? - living a sedentary lifestyle to reduce the incidence of injury - stopping estrogen therapy - taking a 300-mg calcium supplement to meet dietary guidelines - initiating weight-bearing exercise routines

- initiating weight-bearing exercise routines Explanation: - Performing weight-bearing exercise increases bone health - Estrogen is needed to promote calcium absorption - The recommended daily intake of calcium is 1,000 mg, not 300 mg. A sedentary lifestyle increases the risk of developing osteoporosis.

In addition to teaching regarding medications, what would the nurse include to reinforce health promotion and illness prevention for a client with acquired immunodeficiency syndrome (AIDS)? - measures to be taken to prevent transmission, need for isolation precautions at home, and avoidance of infection - measures to prevent transmission, maintaining optimal nutrition, and exercise - importance of safe sex practices, discussion of choices of medications, and hospice care

- measures to prevent transmission, maintaining optimal nutrition, and exercise Explanation: When a client has been identified as human immunodeficiency virus (HIV) positive, prevention of transmission is an important legal consideration. It is also critical to support of the immune system through proper exercise and nutrition. There is no need for isolation precautions at home. The other choices are not appropriate for health promotion and illness prevention.

The nurse is teaching a client with chronic obstructive pulmonary disease (COPD) to assess for signs and symptoms of right-sided heart failure. Which sign/symptom should be included in the teaching plan? - clubbing of nail beds - hypertension - peripheral edema - increased appetite

- peripheral edema Explanation: Right-sided heart failure is a complication of COPD that occurs because of pulmonary hypertension. The signs and symptoms of right-sided heart failure include peripheral edema, jugular venous distention, hepatomegaly, and weight gain due to increased fluid volume. Clubbing of nail beds is associated with conditions of chronic hypoxemia. Hypertension is associated with left-sided heart failure. Clients with heart failure have decreased appetites.

A client who had a three-vessel coronary bypass graft 4 days earlier. The client's cholesterol profile is as follows: total cholesterol 265 mg/dl, low-density lipoprotein (LDL) 139 mg/dl, and high-density lipoprotein (HDL) 32 mg/dl. The nurse should tell the client that - the cholesterol is within the recommended guidelines - the client should take their statin meds - the nurse will ask the dietitian to talk with the client about modifying their diet.

- the nurse will ask the dietitian to talk with the client about modifying their diet. Explanation: A dietitian can help the client decrease the fat in their diet and make other beneficial dietary modifications. This client's total cholesterol isn't within the recommended guidelines; it should be less than 200 mg/dl (5.172 mmol/L). - LDL should be less than 79 mg/dl (2.043 mmol/L) - HDL should be greater than 40 mg/dl (1.034 mmol/L). Although this client should take their statin medication, they should still be concerned about their cholesterol level and make other lifestyle changes, such as dietary changes, to help lower it. The client should increase their activity level, but doesn't need to run 2 miles (3.2 km) per day.

Which clinical characteristic affects client compliance?

the nurse-client relationship

The nurse teaches a client with acute cardiac illness about lifestyle changes. Which statement would lead the nurse to determine that a client lacks understanding or the ability to make lifestyle changes?

- "I already have my airline ticket, so I won't miss my meeting tomorrow." Explanation: Leaving the hospital and immediately flying to a meeting indicate poor judgment by the client and little understanding of what lifestyle changes the client needs to make. The other statements show that the client understands some of the changes that need to be made to decrease stress and lead a healthier lifestyle.

The nurse is assisting the client with irritable bowel syndrome to learn how to effectively adjust the response to work-related stress. Which statement from the client indicates they have understood the instructions? - "My job is too stressful. I will have to find a different career." - "I don't have any control over my stressors at work. My coworkers are difficult to work with." - "I will have to improve my ability to cope with stress."

- "I will have to improve my ability to cope with stress." Explanation: Although clients cannot eliminate stress, they can improve their ability to cope with it. Changing jobs, identifying stressors at work, or setting professional goals a little lower may help a client deal with stress, but improving the ability to cope with stress is most effective.

A client struggling with a binge eating disorder tells a nurse, "I don't know why I eat the way I do each night." What question would be most helpful for the nurse to ask this client?

- "What do you do when you feel stressed or upset?" Explanation: Asking what the client does when they feel stressed or upset is appropriate because clients with binge eating disorder commonly use eating as a distraction from unpleasant or negative feelings. Asking if a client worries that bad things will happen to them indirectly asks about their anxiety. Such a question doesn't focus on exploring the client's statement. A nurse should use a question related to being unable to account for elapsed periods of time to assess a dissociative identity disorder. Asking about a change in the client's leisure activities doesn't relate to the client's statement. This question could apply to any psychiatric disorder that alters the client's lifestyle.

The nurse is developing a health promotion plan with a client with cirrhosis. Which activity should the nurse suggest the client add to the daily routine at home? - Supplement the diet with daily multivitamins. - Abstain from drinking alcohol. - Take a sleeping pill at bedtime. - Limit contact with other people whenever possible.

- Abstain from drinking alcohol. Explanation: General health promotion measures include: - maintaining good nutrition - avoiding infection - abstaining from alcohol. It is not necessary to take multivitamins if the client is obtaining adequate nutrition. Rest and sleep are essential, but an impaired liver may not be able to detoxify sedatives and barbiturates. Such drugs must be used cautiously, if at all, by clients with cirrhosis. The client does not need to limit contact with others but should exercise caution to stay away from ill people.

A group has asked the nurse to discuss how lifestyle factors affect heart health. Which statements indicate that teaching was effective? Select all that apply. - "Gradually increasing my exercise levels enhances circulation heart." - "If I change my diet and lessen my intake of saturated fats and trans fatty acids, this decreases my cholesterol levels." - "if I lose weight and lessen my intake of simple carbohydrates, this should benefit my heart." - "Walking strengthens my heart.

- "Gradually increasing my exercise levels will help enhance circulation through the heart." - "If I change my diet and lessen my intake of saturated fats and trans fatty acids, this may decrease my cholesterol levels." - "As a borderline diabetic, if I lose weight and lessen my intake of simple carbohydrates, this should benefit my heart." - "Walking is excellent exercise to strengthen my heart." Explanation: Increasing exercise levels, diet changes, losing weight, and walking are all important elements of heart health. Chewing tobacco is still harmful to the body.

The nurse is preparing a client with multiple sclerosis (MS) for discharge from the hospital to home. What information should the nurse include in the teaching plan? - "You'll need to accept the necessity of a quiet and inactive lifestyle." - "Keep active, use stress-reduction strategies, and avoid fatigue." - "Follow good health habits to change the course of the disease." - "Practice using the mechanical aids that you'll need when future disabilities arise."

- "Keep active, use stress-reduction strategies, and avoid fatigue." Explanation: The nurse's most positive approach is to encourage a client with MS to keep active, use stress-reduction strategies, and avoid fatigue because it is important to support the immune system while remaining active. A quiet, inactive lifestyle is not necessarily indicated. Good health habits are not likely to alter the course of the disease, though they may help minimize complications. Practicing using aids that will be needed for future disabilities may be helpful but also can be discouraging.

The nurse is conducting discharge education with a client newly diagnosed with Addison disease. Which information should be included in the client and family teaching plan? Select all that apply. - Addison disease will resolve over a few weeks, requiring no further treatment. - Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. - Fatigue, weakness, dizziness, and mood changes need to be reported to the health care provider. - A medical identification brac

- Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. - Fatigue, weakness, dizziness, and mood changes need to be reported to the health care provider. - A medical identification bracelet should be worn. - Family members need to be informed about the warning signals of adrenal crisis. - Dental work or surgery will require adjustment of daily medication. Explanation: Addison disease occurs when the client does not produce enough steroids from the adrenal cortex. Lifetime steroid replacement is needed. The client should be taught: - lifestyle management techniques to avoid stress and maintain rest periods - A medical identification bracelet should be worn - family should be taught signs and symptoms that indicate an impending adrenal crisis, such as fatigue, weakness, dizziness, or mood changes. - Dental work, infections, and surgery commonly require an adjusted dosage of steroids.

The nurse starts an infusion of tissue plasminogen alteplase (tPA) for a client with a cerebrovascular accident (CVA). What are the priority nursing interventions during treatment with this medication? - Lower the head of the bed to decrease risk of a confused client falling during the transfusion. - Conduct frequent neurologic assessments to determine whether the stroke is evolving or acute complications are developing. - Maintain the client's blood pressure slightly below normal ranges to r

- Conduct frequent neurologic assessments to determine whether the stroke is evolving or acute complications are developing. Explanation: Because tPA dissolves clots--clots that are anywhere in the body, not specific to the thrombosed area--neurologic checks are essential. Lowering the head of the bed is incorrect because the nurse wants slight head elevation to promote cerebral drainage of fluid. The pressure should be maintained to avoid further bleeding and/or swelling. The urine output would need frequent monitoring after administration of this medication to assess for any bleeding.

A nurse is evaluating for treatment effectiveness in a client being discharged from the intensive outpatient drug and alcohol clinic. Which client behavior would the nurse evaluate as a positive treatment outcome? - The client is following a regular sleeping routine. - The client is participating in scheduled group meetings. - The client is planning to engage in social activities. - The client is applying the clinic rules to others.

- The client is participating in scheduled group meetings. Explanation: A client with a drug and alcohol problem who is participating in the scheduled group sessions is making an effort to learn lifestyle changes, coping skills, and ways to maintain a clean and sober life.

In addressing health promotion for a patient who is a member of another culture, the nurse should be guided by which principle? - The client may have a very different understanding of health promotion. - A culture's conceptualization of health promotion is a result of that culture's level of socioeconomic development. - The nurse should avoid performing health promotion education if this is not a priority in the client's culture.

- The client may have a very different understanding of health promotion. Explanation: As a component of cultural assessment, the nurse should seek to understand the cultural lens through which the client may understand health promotion. Health promotion is not a concept exclusive to Western cultures, though it may be considered differently among non-Western cultures. Even if health promotion is not a priority in a client's culture, this does not necessarily mean that the nurse should not address issues related to health promotion in a respectful and relevant manner. Health promotion is not directly linked to socioeconomic development levels.

A postpartum client has a nursing diagnosis of risk for impaired urinary elimination related to loss of bladder sensation after birth. What priority outcome criteria should the client achieve? - The client will void more than 30 mL/hour without urinary retention beginning 1 hour after birth. - The client will void a sufficient amount of clear yellow urine 4 hours after birth. - The client will state that she has no discomfort with urinary elimination.

- The client will void more than 30 mL/hour without urinary retention beginning 1 hour after birth. Explanation: A nursing diagnosis of risk for impaired urinary elimination related to loss of bladder sensation after birth can cause several problems for the client. The outcome that is to be achieved is that the client will void more than 30 mL/hour 1 hour after birth and have no urinary incontinence. Voiding a sufficient amount is not a specific outcome and should be measurable. Drinking fluid is not an outcome for risk for impaired urinary elimination and is better suited for the promotion of adequate fluid intake. The client stating that she has no discomfort with urinary elimination does not rule out the risk of impairment of urinary function.

A nurse is teaching a client about maintaining a healthy heart. The nurse should include which point in teaching? - Smoke in moderation. - Use alcohol in moderation. - Consume a diet high in saturated fats and low in cholesterol. - Exercise one or two times per week.

- Use alcohol in moderation. Explanation: The nurse should advise the client that alcohol may be used in moderation as long as there are no other contraindications for its use. Smoking, a diet high in cholesterol and saturated fat, and a sedentary lifestyle are all known risk factors for cardiac disease. The client should be encouraged to quit smoking, exercise three to four times per week, and consume a diet low in cholesterol and saturated fat.

An overweight adolescent has been diagnosed with type 2 diabetes. What should the nurse do to increase the client's self-efficacy to manage the disease? - Provide the client with a written daily food and exercise plan. - Discuss eliminating junk food in the home with the parents. - Arrange for the school nurse to weigh the child weekly. - Utilize a peer with type 2 diabetes to role model lifestyle changes.

- Utilize a peer with type 2 diabetes to role model lifestyle changes. Explanation: Self-efficacy, or the belief that one can act in a way to produce a desired outcome, can be promoted through the observation of role models. Peers are particularly effective role models because clients can more readily identify with them and believe they are capable of similar behaviors. Providing a written plan alone does not promote self-efficacy. Having parents eliminate junk food and having the school nurse weigh the adolescent can be part of the plan, but these actions do not empower the client.

A nursing assessment for a client with alcohol abuse reveals a disheveled appearance and a foul body odor. What is the best initial nursing plan that would assist the client's involvement in personal care? - devising a bathing and dressing schedule for each morning - drawing up a schedule and making certain that it is adhered to - bathing and dressing the client each morning until the client is willing to perform self-care independently - assisting the client with bathing and dressing by givi

- assisting the client with bathing and dressing by giving clear, simple directions Explanation: This action would provide a disorganized client with the necessary structure to encourage participation and support of self-image. The other answers are incorrect because they do not support nurse promotion of client health. The client is not confused and does not require a schedule; however, the client does need some assistance. Full assistance is not required.

A child who limps and has pain has been found to have Legg-Calvé-Perthes disease. What should the nurse expect to include in the child's plan of care? - initiation of pain control measures, especially at night when acute - promotion of ambulation despite the child's discomfort in the affected hip - prevention of flexion in the affected hip and knee - avoidance of weight-bearing on the head of the affected femur

- avoidance of weight-bearing on the head of the affected femur Explanation: Legg-Calvé-Perthes disease, also known as coxa plana or osteochondrosis, is characterized by aseptic necrosis at the head of the femur when the blood supply to the area is interrupted. - Avoidance of weight-bearing is especially important to prevent the head of the femur from leaving the acetabulum, thus preventing hip dislocation. - Devices such as an abduction brace, a leg cast, or a harness sling are used to protect the affected joint while revascularization and bone healing occur. - Surgical procedures are used in some cases. - Although pain control measures may be appropriate, pain is not necessarily more acute at night. - Initial therapy involves rest and non-weight-bearing to help restore motion. - Preventing flexion is not necessary.

Which option is an example of a primary preventive measure?

- avoiding overexposure to the sun Explanation: Primary prevention involves promoting health and helping clients achieve maximum wellness. Primary preventive measures are designed to prevent or delay the onset of specific illnesses; these measures typically include lifestyle changes such as avoiding overexposure to the sun to prevent skin cancer. Annual physical examinations and monthly breast self-examinations are examples of secondary preventive measures, which promote early detection and treatment of disease. Participating in a cardiac rehabilitation program is an example of a tertiary preventive measure, which attempts to prevent complications of an existing disease.

The nurse teaches a client who has recently been diagnosed with hypertension about following a low-calorie, low-fat, low-sodium diet. Which menu selection would best meet the client's needs? - mixed green salad with blue cheese dressing, crackers, and cold cuts - ham sandwich on rye bread and an orange - baked chicken, an apple, and a slice of white bread - hot dogs, baked beans, and celery and carrot sticks

- baked chicken, an apple, and a slice of white bread Explanation: Processed and cured meat products, such as cold cuts, ham, and hot dogs, are all high in fat and sodium and should be avoided on a low-calorie, low-fat, low-salt diet. Dietary restrictions of all types are complex and difficult to implement with clients who are basically without symptoms.

The nurse requests a dinner tray for an adolescent with glomerulonephritis with severe hypertension. Which meal would be most appropriate? - egg noodles, hamburger, canned peas, milk - baked ham, baked potato, pear, canned carrots, milk - baked chicken, rice, green beans, orange juice - hot dog on a bun, corn chips, pickle, cookie, milk

- baked chicken, rice, green beans, orange juice Explanation: The best selection of food would include no added salt or salty food. Because sodium cannot be excreted due to the oliguria and to avoid increasing hypertension, a low-salt diet is recommended. - Most canned foods have sodium added as a preservative - Ham, hot dogs, canned peas, canned carrots, corn chips, pickles, and milk are high in sodium.

A white female client is admitted to an acute care facility with a diagnosis of stroke. Her history reveals bronchial asthma, exogenous obesity, and iron deficiency anemia. Which history finding is a risk factor for stroke? - being white - being female - being obese - having bronchial asthma

- being obese Explanation: Obesity is a risk factor for stroke. Other risk factors include: - a history of ischemic episodes - cardiovascular disease - diabetes mellitus - atherosclerosis of the cranial vessels - hypertension - polycythemia - smoking - hypercholesterolemia - hormonal contraceptive use - emotional stress - family history of stroke - advancing age. The client's race, gender, and bronchial asthma are not risk factors for stroke.

A client has received thrombolytic treatment for an ischemic stroke. The nurse should notify the health care provider (HCP) if there is a rapid increase in which vital signs? - pulse - respirations - blood pressure - temperature

- blood pressure Explanation: - Control of blood pressure is critical during the first 24 hours after treatment because an intracerebral hemorrhage is the major adverse effect of thrombolytic therapy. - Vital signs are monitored, and blood pressure is maintained as identified by the HCP and specific to the client's ischemic tissue needs and risk for bleeding from treatment.

A nurse is preparing a health promotion program for teenagers focusing on lifestyle choices. Which of the following methods used by the nurse will best ensure the success of the program? - creating a safe environment for sharing information - reviewing data about common teenage lifestyle choices - disclosing and explaining personal lifestyle choices - validating the current lifestyle choices of the teenagers

- creating a safe environment for sharing information Explanation: Creating an environment where the teenagers feel safe to share their information leads to therapeutic communication that is client focused. This helps to establish trust, which facilitates a more successful program. The other options block the ability of the teenagers to share their thoughts and feelings openly.

The nurse is providing cost-effective, evidence-based care health education to a client. Which choices are examples of cost-effective, evidence-based care? Select all that apply. - education on healthy dietary choices - education on the client's extended health insurance plan - education on beginning an exercise regime - education on the cost of the client's medical expenses - education on current healthcare legislation

- education on healthy dietary choices - education on beginning an exercise regime Explanation: Cost-effective, evidence-based care includes education on healthy lifestyle choices. Education on extended health insurance plans and medical expenses can be provided but is not considered cost-effective care. Education on healthcare legislation is not the priority.

The children of an elderly client who has suffered an ischemic stroke have informed the nurse that an herbalist will be coming to their parent's bedside tomorrow to make recommendations for client's care. Which considerations should the nurse prioritize in light of the practitioner's planned visit? - ensuring any complementary therapies are safe when combined with his prescribed therapy - ensuring that the care team does not impose their beliefs on the family or the complementary practition

- ensuring any complementary therapies are safe when combined with his prescribed therapy Explanation: While it is important for the nurse and the other members of the care team to ensure that stereotypes or cultural imposition do not exist, the priority in all aspects of care is safety. Consequently, potential interactions between the complementary therapies and conventional hospital treatments are a priority. The family should not be required to forgo conventional treatment to pursue some aspects of culturally based, complementary care.

A client has been diagnosed with osteoporosis after a bone density test and is asking what has caused it. Discussion of risk factors would include: - regular exercise, low fat intake, and recurrent trauma to the bones through increased weight-bearing activities - heavy smoking, sedentary lifestyle, and high intake of carbonated drinks - diet deficient in vegetables and fruits, high intake of red meats, and increased alcohol intake

- heavy smoking, sedentary lifestyle, and high intake of carbonated drinks Explanation: Osteoporosis has been linked to: - heavy smoking - A sedentary lifestyle results in more osteoclastic or breakdown activity rather than bone building or osteoblastic activity - Because carbonated drinks tend to have high phosphate levels, the inverse relationship of phosphorus to calcium results in a depletion of calcium Sunlight exposure for vitamin D and calcium intake all promote bone density. Regular exercise and weight-bearing activities also preserve bone mass A deficient diet has not been proven to contribute to osteoporosis.

A client has risk factors for coronary artery disease, including smoking cigarettes, eating a diet high in saturated fat, and leading a sedentary lifestyle. Which coaching strategies from the nurse will be most effective in assisting the client to improve their health? - explaining how the risk factors lead to poor health - withholding praise until the client changes the risky behavior - helping the client establish a wellness vision to reduce the health risks - instilling mild fear into the cl

- helping the client establish a wellness vision to reduce the health risks Explanation: In health coaching, unlike traditional client education techniques in which the nurse provides information, the goal of coaching is to encourage the client to explore the reasons for the behavior and establish a vision for health behavior changes that will reduce or eliminate health risks. When coaching a client, the nurse does not provide information, withhold praise, or instill fear.

The nurse is caring for a neonate weighing 4536 g (4.5 kg) who was born via cesarean birth 1 hour ago to a client with insulin-dependent diabetes. The client asks the nurse, "Why is my baby in the neonatal intensive care unit?" The nurse bases a response on the understanding that neonates of clients with diabetes commonly develop which condition? - anemia - persistent pulmonary hypertension - hemolytic disease - hypoglycemia

- hypoglycemia Explanation: Hypoglycemia is caused by the rapid depletion of glucose stores. In addition, neonates born to birth parents with insulin-dependent diabetes are 7x more likely to experience respiratory distress syndrome than neonates born to birth parents without diabetes. This neonate should be closely monitored for symptoms of hypoglycemia and respiratory distress. Neonates of birth parents with diabetes commonly have polycythemia, not anemia. Anemia and hemolytic disease are associated with erythroblastosis fetalis. Persistent pulmonary hypertension is associated with meconium aspiration syndrome.

A 17-year-old adolescent with acute lymphocytic leukemia is discharged with written information about chemotherapy administration and an outpatient appointment schedule. The client now is in the maintenance phase of chemotherapy but has missed clinic appointments for blood work and admits to omitting some chemotherapy doses. To improve the client's compliance, the nurse should include which intervention in the care plan?

- letting the adolescent participate in planning and scheduling of treatments Explanation: Because the adolescent is striving for independence, healthcare providers should promote self-reliance whenever possible, such as by letting the client participate in planning and scheduling treatments. The client can help establish realistic goals and evaluation outcomes as well as help schedule procedures and chemotherapy doses to minimize lifestyle disruptions. Adolescents are oriented in the present and have relatively little concern for the long-term consequences of their behavior. Reprimanding the client or threatening to discontinue care isn't likely to improve compliance and isn't in the client's best interest.

A 75-year-old client is newly diagnosed with diabetes. The nurse is instructing them about blood glucose testing. After the session, the client states, "I can't be expected to remember all this stuff." The nurse should recognize this response as most likely related to which factor? - moderate to severe anxiety - disinterest in the illness - early-onset dementia - normal reaction to learning a new skill

- moderate to severe anxiety Explanation: Anxiety, especially at higher levels, interferes with learning and memory retention. After the client's anxiety lessens, it will be easier for the client to learn the steps of blood glucose monitoring. Because the client's illness is a chronic, lifelong illness that severely changes lifestyle, it is unlikely that the client is uninterested in the illness or how to treat it. It is also unlikely that dementia would be the cause of the client's frustration and lack of memory. The client's response indicates anxiety. Client responses that would indicate decreased anxiety would be questions to the nurse or requests to repeat part of the instruction.

A client is admitted to an acute care facility with a diagnosis of stroke. The nursing student is reviewing the client's history. Which history findings noted will the student report as risk factors for stroke? Select all that apply. - Caucasian race - female sex - obesity - smoking ½ pack of cigarettes a day - hypertension

- obesity - smoking ½ pack of cigarettes a day - hypertension Explanation: Obesity, smoking, and hypertension are risk factors for stroke. Other risk factors include: - a history of ischemic episodes - cardiovascular disease - diabetes mellitus - atherosclerosis of the cranial vessels - polycythemia - hypercholesterolemia - oral contraceptive use - emotional stress - family history of stroke - advancing age. This client's race and sex are not risk factors for stroke.

Which goal is a priority for the diabetic client who is taking insulin and has nausea and vomiting from a viral illness or influenza? - obtaining adequate food intake - managing own health - relieving pain - increasing activity

- obtaining adequate food intake Explanation: The priority goal for the client with diabetes mellitus who is experiencing vomiting with influenza is to obtain adequate nutrition. - The diabetic client should eat small, frequent meals of 50 g of carbohydrate or food equal to 200 calories every 3 to 4 hours. If the client cannot eat the carbohydrates or take fluids, the health care provider (HCP) should be called, or the client should go to the emergency department. The diabetic client is in danger of complications with: - dehydration - electrolyte imbalance - ketoacidosis Increasing the client's health management skills is important to lifestyle behaviors, but it is not a priority during this acute illness of influenza. Pain relief may be a need for this client, but it is not the priority at this time; neither is increasing activity during the illness.

What instruction should the nurse's discharge teaching plan for the client with heart failure include? - maintaining a high-fiber diet - walking 2 miles (3.2 km) every day - obtaining daily weights at the same time each day - remaining sedentary for most of the day

- obtaining daily weights at the same time each day Explanation: Heart failure is a complex and chronic condition. Education should focus on health promotion and preventive care in the home environment. Signs and symptoms can be monitored by the client. Instructing the client to obtain daily weights at the same time each day is very important. The client should be told to call the health care provider (HCP) if there has been a weight gain of 2 lb (0.91 kg) or more. This may indicate fluid overload, and treatment can be prescribed early and on an outpatient basis, rather than waiting until the symptoms become life threatening. The client's exercise program would need to be planned in consultation with the HCP and based on the history and the physical condition of the client. The client may require exercise tolerance testing before an exercise plan is laid out. Although the nurse does not prescribe an exercise program for the client, a sedentary lifestyle should not be recommende

A client is admitted to the rehabilitation unit after a cerebrovascular accident (or brain attack). The client is bedridden and aphasic. When assessing the client's emotional response to the illness, what would the nurse most want to explore? - past experiences and coping abilities - frustration with changes in lifestyle - willingness to participate in rehabilitation - ability to understand the illness

- past experiences and coping abilities Explanation: It is very important to explore a client's past challenges and coping abilities. This information will help the nurse understand the client's resiliency and know how best to support the client.

A client is discharged to a heart rehabilitation program. What lifestyle changes would be appropriate for the nurse to review? - reducing the intake of unsaturated fats, participating regularly in anaerobic burst training activity, and increasing fluid intake - reducing the intake of calcium and increasing the intake of sodium, and incorporating rest periods - reducing cholesterol levels, increasing activity levels progressively, and coping strategies - increasing homocysteine levels, reducing

- reducing cholesterol levels, increasing activity levels progressively, and coping strategies Explanation: Cardiac rehabilitation is designed to assist the client in regaining functioning gradually. It also includes: - heart-healthy information such as dietary changes - a progressive increase in activity - effective coping strategies for stress reduction. The emphasis is on lifestyle changes and reducing the risk of recurrence. The information related to unsaturated fats and participation in burst training is inaccurate. There is no need to reduce calcium intake and sodium is not increased. Homocysteine levels should be decreased, not increased.

A client with rheumatoid arthritis tells the nurse that they feel "quite alone" in adjusting to changes in their lifestyle. Which response by the nurse will be most effective? - referring the client and partner for counseling to decrease the sense of isolation - suggesting that the client develop a hobby to occupy their time - telling the client about a community arthritis support group - recommending that the client discuss their feelings with their religious advisor

- telling the client about a community arthritis support group Explanation: The client should be encouraged to join the community arthritis support group so that they can share their feelings with others who are facing similar experiences with this chronic illness and can identify with their concerns. A hobby will not help the client resolve their feelings of being alone. Seeking counseling or discussing their feelings with a religious advisor may be helpful, but these activities will not necessarily help the client to understand that there are many individuals who must adjust their lifestyles because of arthritis and that they are not alone.

A client has been diagnosed with early alcoholic cirrhosis. The client should be taught which behavior could potentially reverse the pathologic changes occurring in the liver? - Do not become fatigued. - Avoid drinking alcohol. - Eliminate smoking. - Eat a high-carbohydrate, low-fat diet.

- Avoid drinking alcohol. Explanation: Alcoholic cirrhosis is associated with excessive alcohol intake. In the early stages, the liver develops fatty changes. If alcohol intake stops, the fatty changes can be reversed. - Avoiding overexertion is important in the client with cirrhosis, but it does not reverse the disease. - Stopping smoking is a positive, healthy lifestyle change, but it does not have an impact on cirrhosis. - A diet high in carbohydrates and low in fat is also recommended for the client with cirrhosis, but the diet does not reverse the pathologic changes that have occurred in the liver.

A 16-year-old adolescent is brought to the clinic for evaluation for a suspected eating disorder. To best assess the effects of role and relationship patterns on the client's nutritional intake, the nurse should ask: - "What activities do you engage in during the day?" - "Do you have any allergies to foods?" - "Do you like yourself physically?" - "What kinds of foods do you like to eat?"

- "Do you like yourself physically?" Explanation: Role and relationship patterns focus on body image and the client's relationship with others, which commonly interrelate with food intake. Therefore, asking the adolescent about physical self-image is appropriate. Questions about activities and food preferences elicit information about health promotion and health protection behaviors, not role and relationship patterns. Questions about food allergies elicit information about health and illness patterns.

The nurse is conducting a health history for a client at risk for cancer. Which lifestyle factor is considered a risk for colorectal cancer? - a diet low in vitamin C - a high dietary intake of artificial sweeteners - a high-fat, low-fiber diet - multiple sex partners

- a high-fat, low-fiber diet Explanation: A high-fat, low-fiber diet is a risk factor for colorectal cancer. A diet low in vitamin C, use of artificial sweeteners, and multiple sex partners are not considered risk factors for colorectal cancer.

The nurse is teaching a client with ulcerative colitis about maintaining a healthy lifestyle. Which statement indicates the client understands the nurse's instructions? - "I may have coffee with my meals." - "I'm allowed to have alcohol as long as I only drink wine." - "I'll have to stop smoking." - "I can eat popcorn for an evening snack."

- I'll have to stop smoking." Explanation: Tobacco, caffeine, and alcohol are gastrointestinal stimulants and should be avoided by clients with ulcerative colitis. High-fiber foods such as popcorn and nuts are not allowed because of potential gastrointestinal irritation.

The nurse is planning a health promotion class with a group of middle-age women. What information should the nurse include in the lesson plan about reducing the risk for developing osteoarthritis? - Follow a high-protein diet. - Exercise at least twice a week. - Maintain a normal weight. - Take a multivitamin supplement daily.

- Maintain a normal weight. Explanation: Obesity is a risk factor for osteoarthritis because it places increased stress on the joints. A high-protein diet, regular exercise, and vitamin supplements do not reduce a client's risk for developing osteoarthritis.

After instructing a multigravid client at 10 weeks' gestation diagnosed with chronic hypertension about the need for frequent prenatal visits, the nurse determines that the instructions have been successful when the client makes which statement? - "I may develop hyperthyroidism because of my high blood pressure." - "I need close monitoring because I may have a small-for-gestational-age infant." - "It is possible that I will have excess amniotic fluid and may need a cesarean birth." - "I may dev

- "I need close monitoring because I may have a small-for-gestational-age infant." Explanation: Clients with chronic hypertension, diabetese & multiparas during pregnancy are at risk for complications such as: -preeclampsia (about 25%) - abruptio placentae - intrauterine growth retardation, resulting in a small-for-gestational-age infant. There is no association between chronic hypertension and hyperthyroidism. Pregnant clients with chronic hypertension are not at an increased risk for hydramnios (polyhydramnios), an abnormally large amount of amniotic fluid. Placenta accreta, a rare placental abnormality, refers to a condition in which the placenta abnormally adheres to the uterine lining. It is not associated with chronic hypertension.

A nurse is teaching self-esteem to a client. Which statements by the client would indicate understanding of the concept? Select all that apply. - "I need to have consistent limits." - "Living in a critical environment is not good for me." - "I need to have healthy boundaries." - "Physical discipline does not affect my self-esteem." - "I do not like to make decisions."

- "I need to have consistent limits." - "Living in a critical environment is not good for me." - "I need to have healthy boundaries." Explanation: Self-esteem is how we value or feel worthwhile about ourselves. A variety of factors can aide a person in developing a healthier self-esteem. Here are a few: A structured lifestyle demonstrates acceptance and caring and provides a sense of security. A critical environment erodes a person's esteem. Inconsistent boundaries lead to feelings of insecurity and lack of concern. Physical discipline can decrease self-esteem. When the client starts to make decisions, this can help increase their self-esteem.

After teaching a client about myasthenia gravis, the nurse would judge that the client has formed a realistic concept of the disease and the treatment plan when the client makes which statement? - "I'll live longer, but ultimately the disease will cause death." - "My symptoms will be controlled, and eventually I will be cured." - "I'll be able to control the disease and enjoy a healthy lifestyle." - "I won't be so tired, but I can expect occasional periods of muscle weakness."

- "I'll be able to control the disease and enjoy a healthy lifestyle." Explanation: With a well-managed regimen, a client with myasthenia gravis should be able to control symptoms, maintain a normal lifestyle, and achieve a normal life expectancy. Myasthenia gravis can be controlled and need not be a fatal disease. Myasthenia gravis can be controlled, not cured. Episodes of increased muscle weakness should not occur if treatment is well managed.

A nurse is assessing a client for lifestyle factors that might affect normal coping. Which factor should the nurse most likely consider? - inadequate diet - divorce - job promotion - adopting a child

- inadequate diet Explanation: Poor, inadequate diet is the only option considered a lifestyle factor. Divorce, job promotion, and adopting a child are considered life events.

A nurse is obtaining the health history of a client whose background differs from the nurse's. To develop culturally acceptable strategies for nursing care, the nurse should assess which client factor? - marital status - tradition and ethnic factors - financial resources - community involvement

- tradition and ethnic factors Explanation: Assessing the client's tradition and ethnic factors helps the nurse identify behaviors that should be taken into account when planning the client's care. Although the nurse also must consider the client's marital status, financial resources, and community involvement when planning care and rehabilitation, these factors have little relevance when the nurse is formulating culturally acceptable strategies for nursing care.

To prevent recurrence of cystitis, the nurse should plan to encourage a female client to include which measure in their daily routine? - wearing cotton underpants - increasing citrus juice intake - douching regularly with 0.25% acetic acid - using vaginal sprays

- wearing cotton underpants Explanation: A woman can adopt several health-promotion measures to prevent the recurrence of cystitis, including avoiding: - too-tight pants - noncotton underpants - irritating substances, such as bubble baths and vaginal soaps and sprays. - Increasing citrus juice intake that can irritate bladder - Regular douching since it can alter the pH of the vagina, increasing the risk for infection.

During a home visit, the nurse discovers that the client is less verbal, less active, less responsive to directions, severely anxious, and more dazed. The nurse interprets these findings to indicate that the client needs which intervention? - a sleep aid - a clinic appointment - an increase in medication - an immediate medical evaluation

- an immediate medical evaluation Explanation: The client is exhibiting symptoms of becoming catatonic and unable to care for himself and needs immediate evaluation and possible hospitalization. A sleep aid is not sufficient to treat this client. The client's worsening condition dictates action without waiting for a clinic appointment. An increase in medication may be indicated, but hospitalization is required first for safety.

A mother states that she is very angry with the health care provider who diagnosed her child with leukemia. Which statement helps the nurse understand this mother's reaction? - Anger is a natural result of a sense of loss and helplessness. - Parents of sick children are usually unable to control their anger. - Anger is rarely demonstrated by parents when coping with a sick child. - The mother cannot overcome her anger in an acceptable manner.

- Anger is a natural result of a sense of loss and helplessness. Explanation: Anger is a natural result of feelings of loss and helplessness in normal, healthy people. It is a natural response to coping with a sick child. Nurses should recognize anger in clients and families. Parents are usually able to control their anger in a socially acceptable manner. Nurses can assist clients and families to overcome helplessness and anger in an acceptable manner.

When teaching caregiver of a client with congenital heart disease, the nurse should explain all medical treatments and emphasize which instruction? - "Reduce your child's caloric intake to decrease cardiac demand." - "Relax discipline and limit-setting to prevent crying." - "Make sure your child avoids contact with small children to reduce overstimulation." - "Try to maintain your child's usual lifestyle to promote normal development."

- "Try to maintain your child's usual lifestyle to promote normal development." Explanation: The nurse should encourage the caregivers of a client with a congenital heart defect to treat the client normally and allow self-limited activity. Telling the caregivers to reduce the client's caloric intake isn't appropriate because doing so wouldn't necessarily reduce cardiac demand. Telling the caregivers to alter disciplinary patterns and deliberately prevent crying or interactions with other children could foster maladaptive behaviors. Contact with peers promotes normal growth and development.

The nurse correctly judges that the danger of a suicide attempt is greatest with which client behavior? - resumption of former lifestyle - increase in energy level - at the point of deepest despair - willingness to visit with an estranged sibling

- increase in energy level Explanation: The client's energy level is related to the danger involved. Suicide attempts are more likely to be carried out when the client has more energy to act on thoughts and impulses. A client may not have the energy to commit suicide during times of severe depression. Resuming a former lifestyle is usually a sign of improvement unless the lifestyle places the client in danger. Visiting an estranged sibling does not indicate that a suicide attempt is imminent.

Which questions should the nurse include in a cultural assessment? Select all that apply. - "What do you think is causing your illness?" - "To what religion do you belong?" - "What do you do to promote good health?" - "Do you have a particular name for this illness?" - "What do you think about religions other than yours?"

- "What do you think is causing your illness?" - "To what religion do you belong?" - "What do you do to promote good health?" - "Do you have a particular name for this illness?" Explanation: Transcultural assessment encompasses several considerations surrounding illness, such as: - causation - naming - prevention - health promotion - to ask what religion or religious group a client identifies. However, it is likely unnecessary and possibly inappropriate to elicit the client's views of those who belong to other religious groups.

A nurse is teaching a group of middle-aged clients about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention - a sedentary lifestyle and smoking. - a history of hemorrhoids and smoking. - alcohol abuse and a history of acute renal failure. - alcohol abuse and smoking.

- alcohol abuse and smoking. Explanation: The nurse should mention that risk factors for peptic (gastric and duodenal) ulcers include: - alcohol abuse - smoking - stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.

The nurse is preparing a preoperative teaching plan for a client who is undergoing a bilateral breast reduction. Which aspect of the plan is the priority? - reduction of risk potential - physiologic adaptation - psychosocial integrity - health promotion and maintenance

- psychosocial integrity Explanation: - Psychosocial integrity issues, including coping mechanisms, situational role changes, and body image changes, are more common in a client who undergoes elective cosmetic surgical procedures. - Reduction of risk potential, physiologic adaptation, and health promotion and maintenance are greater needs for clients who are undergoing surgical correction of functional, anatomic, or physiologic defects in nonelective surgical procedures.

The nurse is teaching a group of women health-promotion activities to reduce the incidence of osteoporosis. What should the nurse include in the teaching plan? - importance of obtaining an adequate calcium intake - how to administer oral pain medication safely - importance of increasing caffeine intake - need to avoid estrogen replacement therapy when postmenopausal

- importance of obtaining an adequate calcium intake Explanation: - To reduce the risk for osteoporosis, women should have an intake of 1000 to 1500 mg of calcium per day. - Estrogen replacement therapy helps prevent bone loss and osteoporosis. Taking oral pain medication occasionally does not influence the development of osteoporosis. Caffeine intake is considered a contributing factor to osteoporosis.

A nurse is assisting in the discharge planning for a client with alcoholism. Which actions should be included in the discharge plan? Select all that apply. - Strongly encourage participation in Alcoholics Anonymous (AA). - Provide nutritional information and counseling. - Establish an exercise program. - Discuss relapse prevention. - Have the client slowly introduce themself to people from their former lifestyle.

- Strongly encourage participation in Alcoholics Anonymous (AA). - Provide nutritional information and counseling. - Establish an exercise program. - Discuss relapse prevention. Explanation: AA is an outpatient support group for recovering alcoholics. It allows clients to share their problems and gain support from members of the group to avoid further alcohol abuse. The nurse should: - strongly encourage the client to participate in this support group - provide the client with nutritional information and counseling, particularly if the client is underweight or malnourished. - Establishing an exercise program is appropriate for the client's physical health. - discourage the client from reestablishing relationships with former "drinking friends" because this could lead to relapse.

When developing a teaching plan about contraception with a 37-year-old female client during their annual gynecologic examination, which should the nurse identify as contraindications to combined oral contraceptive use? Select all that apply. - smoking 1 pack of cigarettes per day - maternal parent with a history of lymphoma - healing of a currently casted fractured femur. - use of phenytoin for a seizure disorder - history of asthma - multiple sexual partners

- smoking 1 pack of cigarettes per day - healing of a currently casted fractured femur. - use of phenytoin for a seizure disorder Explanation: Absolute contraindications to oral contraceptives include: - prolonged immobilization or surgery to the leg - age of more than 35 years when a cigarette smoker especially in those women who smoke more than 20 cigarettes a day - Oral contraceptives also interact with many antiepileptic drugs including phenytoin, causing a reduction in the therapeutic dose and alteration in the seizure threshold. Multiple sexual partners is not a contraindication and is often a lifestyle situation in which pregnancy is undesired. Female clients with asthma can safely take oral contraceptives. There is no link between maternal or personal history of lymphoma and oral contraceptives.

The health care team determines that the family of an infant with failure to thrive who is to be discharged will need follow-up care. Which approach would be the most effective method of follow-up? - daily phone calls from the hospital nurse - enrollment in community parenting classes - twice-weekly clinic appointments - weekly visits by a community health nurse

- weekly visits by a community health nurse Explanation: The most effective follow-up care would occur in the home environment. The community health nurse can be supportive of the parents and will be able to observe parent-infant interactions in a natural environment. The community health nurse can evaluate the infant's progress in gaining weight, offer suggestions to the parents, and help the family solve problems as they arise.

A 17-year-old adolescent with acute lymphocytic leukemia is in the maintenance phase of chemotherapy but has missed clinic appointments and admits to omitting some chemotherapy doses. Which interventions should the nurse include in the care plan to ensure compliance? Select all that apply. - Discussing the long-term consequences of non-adherence - Exploring reasons why the adolescent has failed to comply with treatment - Letting the adolescent participate in planning and scheduling of treatment

- Exploring reasons why the adolescent has failed to comply with treatment - Letting the adolescent participate in planning and scheduling of treatments

The nurse is developing an education plan for clients with hypertension. The nurse should emphasize which long-term goal for the clients? - Develop a plan to limit stress. - Participate in a weight-reduction program. - Commit to lifelong therapy. - Monitor blood pressure regularly.

- Commit to lifelong therapy. Explanation: The most appropriate long-term goal for the client with hypertension is to commit to lifelong therapy. A significant problem in the long-term management of hypertension is compliance with the treatment plan. It is essential that the client understand the reasons for modifying their lifestyle, taking prescribed medications, and obtaining regular health care. Limiting stress, losing weight, and monitoring blood pressure are important aspects of care for the client with hypertension; however, the treatment plan must be individualized to include aspects of care that are appropriate for each client.